Provider Demographics
NPI:1528592102
Name:STEPNICKA, COURTENEY
Entity Type:Individual
Prefix:
First Name:COURTENEY
Middle Name:
Last Name:STEPNICKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 W HIBISCUS BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2622
Mailing Address - Country:US
Mailing Address - Phone:321-345-4232
Mailing Address - Fax:321-765-6434
Practice Address - Street 1:1855 W HIBISCUS BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2622
Practice Address - Country:US
Practice Address - Phone:321-345-4232
Practice Address - Fax:321-765-6434
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1732435106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1732435OtherRBT